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[Plasma citrulline concentration as a biomarker of intestinal function in short bowel syndrome and in intestinal
R Vecino López1, A M Andrés Moreno, E Ramos Boluda
1Servicio de Gastroenterología Infantil, Hospital Infantil La Paz, Madrid, España.
Insights
Serum citrulline effectively indicates enterocyte load in children with short bowel syndrome (SBS) and is linked to feeding tolerance. This biomarker shows promise for assessing intestinal adaptation and rejection in transplant patients.
Area of Science:
- Biochemistry
- Pediatric Gastroenterology
- Transplant Surgery
Context:
- Short bowel syndrome (SBS) presents a significant challenge in pediatric gastroenterology, impacting nutrient absorption and overall health.
- Assessing enterocyte function and load is crucial for managing intestinal failure and guiding treatment strategies.
- Enteral adaptation and the risk of rejection in small bowel transplant recipients require reliable biomarkers.
Purpose:
- To investigate serum citrulline as a biomarker for enterocyte load in children with SBS.
- To analyze the relationship between serum citrulline levels and enteral feeding tolerance.
- To explore the potential of citrulline in predicting intestinal adaptation and rejection post-transplant.
Summary:
- Plasma citrulline levels were measured in 57 children with intestinal failure due to SBS, categorized into four groups based on nutritional support and transplant status.
- Significantly lower citrulline levels were observed in patients solely dependent on parenteral nutrition compared to those on mixed or full enteral diets.
- Citrulline levels correlated with remnant small bowel length and showed potential as a marker for rejection in small bowel transplant recipients.
Impact:
- Plasma citrulline can serve as a sensitive biomarker for residual functional enterocyte mass.
- Citrulline levels are associated with the tolerance of enteral feeding in pediatric patients with SBS.
- Further research is needed to confirm the prognostic value of citrulline in intestinal adaptation and as a rejection marker in small bowel transplantation.
Introduction:
Citrulline is a non-essential amino acid produced solely in the enterocyte. The aim of this study was to analyse the role of serum citrulline as a biomarker of enterocyte load in children with intestinal failure due to short bowel syndrome (SBS) and its relationship to enteral adaptation.
Material And Methods:
Plasma citrulline concentration was determined by chromatography (normal value>15 μmol/L) in 57 patients (age 0.5-18 years) admitted to our Intestinal Rehabilitation Unit with intestinal failure. Those who were dehydrated, with renal insufficiency, or other conditions able to modify the results were excluded. Patients were divided into 4 groups: group i: SBS totally dependent on parenteral nutrition (PN); group ii: SBS under mixed enteral-parenteral nutrition; group iii: IF weaned from PN after a rehabilitation period; group iv: small bowel transplanted patients weaned from PN and taking a normal diet.
Results:
The mean ± SD plasma citrulline values were: group i (n=15): 7.1 ± 4.1; group ii (n=11): 15.8 ± 8.9; group iii (n=13): 20.6 ± 7.5; group iv (n=25): 28.8 ± 10.1. Values were significantly lower in group i in comparison with groups ii-iii-iv (P<.001), and in group ii in comparison with groups iii-iv (P<.001). A low citrulline was associated with remnant small bowel length (P<.001, r=0.85). In group iv citrulline levels decreased >50% in 3 patients who developed moderate-severe rejection, and in one patient who developed viral enteritis.
Conclusions:
1. Plasma citrulline could be a sensitive and specific biomarker of the residual functional enterocyte load. 2. It is related to enteral feeding tolerance. 3. Its prognostic value in the process of intestinal adaptation and as a rejection marker in small bowel transplanted patients needs to be confirmed.
